Effect of Mixed Reality-Assisted Preoperative Anesthesia Visits on Anxiety in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

Abstract Background Preoperative anxiety is common among surgical patients and may adversely affect perioperative outcomes. Mixed reality (MR) offers an immersive approach to preoperative education and may improve patients’ perioperative experience. This randomized controlled trial aimed to evaluate whether an MR-assisted preoperative anesthesia visit could reduce preoperative anxiety in patients undergoing elective laparoscopic surgery. Methods This prospective, single-center, randomized controlled trial was conducted at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Participants were randomly assigned to an MR-assisted preoperative anesthesia visit delivered through an MR headset or to a standard preoperative anesthesia visit. The primary outcome was the total Amsterdam Preoperative Anxiety and Information Scale (APAIS) score immediately after the intervention (T1). Secondary outcomes included perioperative pain and postoperative quality of recovery. In a subset of participants in the MR group, single-channel electroencephalography (EEG) was recorded during the intervention for exploratory, descriptive analysis. Results Of 76 patients assessed for eligibility, 56 were randomized and 55 were included in the analysis (MR group, n = 27; control group, n = 28). At T1, the mean total APAIS score was lower in the MR group than in the control group (12.04 ± 3.63 vs. 15.07 ± 2.99), with an estimated between-group difference of − 3.03 points (95% CI, − 4.84 to − 1.23; P = 0.001). The difference remained at arrival in the operating room (T2: 12.33 ± 3.82 vs. 15.43 ± 2.92; P = 0.002). The distributions of preoperative Numerical Rating Scale (NRS) pain scores differed between groups at T1 and T2. The Quality of Recovery-15 (QoR-15) score was higher in the MR group at 24 h after surgery, whereas no between-group difference was observed at 48 h. Exploratory EEG recordings from the MR subgroup showed descriptive changes in the α/β and β/θ power ratios across intervention modules. Conclusion MR-assisted preoperative anesthesia visits reduced preoperative anxiety in adults undergoing elective laparoscopic surgery. Differences in preoperative pain-score distributions and early postoperative quality of recovery also favored the MR group, although these secondary findings require confirmation. The EEG findings were descriptive and should be interpreted as hypothesis-generating.